Evolving Trends of Button Battery Ingestion in Indian Children at a Tertiary Care Hospital

Abstract

IntroductionForeign body ingestion is a common problem encountered in the pediatric age group. Impaction of lithium batteries of greater than 20-mm diameter in the esophagus is associated with severe complications. This study aimed at analyzing the evolving trends of button battery ingestion in pediatric age groups at our tertiary care center in terms of clinical presentation, intraoperative findings, and the correlation of various clinical variables.MethodsA retrospective observational study was done. All children younger than 18 years with impaction of a button battery of size greater than 20 mm in the esophagus between January 2015 and December 2018 were included in the study. All children underwent removal of the battery using direct laryngoscopy/rigid esophagoscopy under general anesthesia.ResultsThere were 100 children included in the study with a mean age of 29.92 months having 93 children (93%) younger than 6 years. The mean duration of impaction was 34.7 hours. Increased duration of impaction was associated with an increased risk of complications and an increased difficulty in removal. There was a significant correlation between the site of impaction and the age of the patient. Complications were seen in 10% of cases with severe complications in 6 cases. No fatalities were reported in this study.ConclusionsButton batteries impacted in the esophagus can lead to severe complications including death. There has been an increasing trend in the ingestion of button batteries over the last 4 years. A prompt diagnosis and emergent removal of the battery are crucial to minimize the rate of complications. Symptoms of stridor and dysphagia must be given more attention, and these children are prioritized because they are more prone to have complications. Furthermore, primary prevention and caregiver education should be emphasized, and the need for a legislation to change the policies for securing the batteries in their products must be endorsed.

Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children

“…As per the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society of Pediatric Gastroenterology Hepatology, and Nutrition, esophageal button batteries should be removed emergently by upper endoscopy or rigid endoscopy, ideally within 2 h of ingestion [49,57]. Isolated button batteries in the stomach that are asymptomatic are less concerning, as the majority pass through the gastrointestinal tract and very uncommonly require any intervention [1]. In asymptomatic patients with a gastric button battery, abdominal x-rays should be repeated in 10 to 14 days and removed endoscopically if it remains in the stomach, or within 2 h if symptoms develop (Fig.…”

“…Button batteries are commonly found in household items such as toys, watches, jewelry, calculators, flashlights, remote controllers, fobs, hearing aids, and other electronic items [1,41,42]. Their smooth and shiny appearance makes them appealing to young children [42].…”

“…Button battery ingestions are on the rise, with one study using data from National Electronic Injury Surveillance System demonstrating 70,322 battery-related ingestions in the USA from 2010 to 2019, with a statistically significant increase in ED visits during this time [44 && ]. There has also been a substantial increase in ingestions with major adverse outcomes or fatalities, which has been linked with both the increase in the market of 20-mm diameter button batteries and highervoltage lithium batteries [1,41,[45][46][47].…”

“…Button batteries 20-mm often become impacted in the esophagus, especially in children less than 6 years of age, although serious harm has also occurred to children who have ingested batteries <20 mm in size [1,41,48]. Button batteries that pass into the stomach can still cause injury, however complications and the need for interventions in these cases are rare [1,49].…”

“…Children are particularly vulnerable to foreign body and toxic ingestions. Characteristics that place children at increased risk for these ingestions and subsequent complications include their curiosity, limited ability to distinguish edible from nonedible products, tendency to explore things by placing them in their mouth, fewer teeth, and lack of coordination between chewing and swallowing [1][2][3]. Children less than 6 years of age are at increased risk of esophageal impaction given their smaller diameter esophagus [3].…”